Vaginal discharge is common and normal in reproductive-age women and is related to changes in estrogen levels during the menstrual cycle. However, changes in vaginal discharge color, volume, or odor are concerning for infection.
The appearance of vaginal discharge caused by these various etiologies may have some overlap and is not always reliable; therefore, wet mount microscopy and vaginal pH testing are performed to confirm the diagnosis.
(Choices B, D, and E) Chlamydia trachomatis, Mycoplasma genitalium, and Neisseria gonorrhoeae are causes of acute cervicitis, which can present with dyspareunia and discharge. However, patients typically have a mucopurulent cervical discharge that may be accompanied by dysuria (eg, urethritis) or abdominal pain (ie, pelvic inflammatory disease). There is no associated vulvovaginal erythema.
Candidiasis and trichomoniasis typically have generalized vulvovaginal inflammation with erythema on physical exam
<aside> 💡 Actinomyces does not cause vaginitis and is not visualized on wet mount microscopy, it causes PID in patients with IUDs
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Multinucleated giant cells are occasionally seen on cervical cytology (rather than microscopy) in patients with herpes simplex virus. Herpes simplex virus is a rare cause of cervicitis, but patients typically have concomitant, painful vulvovaginal vesicles.
Patients with chlamydia cervicitis can have a malodorous vaginal discharge; however, they typically have multiple white blood cells on microscopy rather than coated epithelial cells.
Povidone-iodine vaginal douches are typically used as a general antimicrobial cleanser for preoperative preparation for vaginal surgery (eg, hysteroscopy, total vaginal hysterectomy). Povidone-iodine vaginal douches are an ineffective therapy for BV.
inside of the vagina and the use of soaps with perfumes and irritating chemicals are risk factors for bacterial vaginosis because they disturb the normal vaginal microflora. Vaginal douching decreases the amount of lactic acid-producing lactobacilli, which leads to an increase in the pH balance. A pH higher than 4.5 is no longer acidic enough to prevent the proliferation of certain organisms, and contributes, e.g., to an increase in Gardnerella vaginalis. But it doesn’t increase the risk of vaginal candidiasis.